Citation Nr: 0528329
Decision Date: 10/20/05 Archive Date: 11/01/05
DOCKET NO. 97-22 711 ) DATE
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On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO)
in Buffalo, New York
THE ISSUES
1. Entitlement to service connection for hypertension,
claimed as secondary to a service-connected bipolar
disability.
2. Entitlement to service connection for a heart disorder,
claimed as secondary to a service-connected bipolar
disability.
REPRESENTATION
Appellant represented by: The American Legion
WITNESS AT HEARING ON APPEAL
The veteran
ATTORNEY FOR THE BOARD
Hammon, P.J. Associate Counsel
INTRODUCTION
The veteran served on active duty from August 1967 to January
1971. He is a combat veteran.
This case comes to the Board of Veterans' Appeals (Board) on
appeal from a July 1996 RO decision.
In July 1999 and October 2003, the Board remanded the case to
the RO for additional development.
FINDINGS OF FACT
1. VA notified the veteran of the evidence needed to
substantiate his claim, explained to him who was responsible
for submitting such evidence, and obtained and fully
developed all other evidence necessary for an equitable
disposition of the claim.
2. The currently demonstrated hypertension is shown to have
been aggravated by the veteran's service-connected diabetes
mellitus and bipolar disorder.
3. The currently demonstrated arteriosclerotic heart disease
is shown to have been aggravated by the veteran's service-
connected diabetes mellitus and bipolar disorder.
CONCLUSIONS OF LAW
1. The veteran's disability manifested by hypertension is
proximately due to or the result of service-connected
disability. 38 U.S.C.A. §§ 1110, 1131, 5103, 5107, 7104
(West 2002); 38 C.F.R. § 3.303, 3.310 (2005).
2. The veteran's disability manifested by arteriosclerotic
heart disease is proximately due to or the result of service-
connected disability. 38 U.S.C.A. §§ 1110, 1131, 5103, 5107,
7104 (West 2002); 38 C.F.R. § 3.303, 3.310 (2005).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
I. Preliminary Matters
The Veterans Claims Assistance Act of 2000 (VCAA), Public Law
No. 106-475, 114 Stat. 2096 (2000), substantially amended the
provisions of chapter 51 of title 38 of the United States
Code, concerning the notice and assistance to be afforded to
claimants in substantiating their claims. VCAA § 3(a), 114
Stat. 2096, 2096-2097 (2000) (now codified as amended at 38
U.S.C.A. §§ 5103, 5103A (West 2002).
The Board finds that VA has satisfied its duty under VCAA to
notify and assist the veteran and that any error is harmless
given the favorable action taken hereinbelow. 38 U.S.C.A. §§
5103 and 5103A (West 2002).
II. Factual Background
In an April 1996 letter, a private physician treating the
veteran stated that he had no doubt that, under extreme
emotional distress, elevated levels of catecholamine and
hypertensive response, could create symptoms in a patient
with underlying heart disease.
He went on to state that, although it was not unlikely that
the veteran would have developed his heart problems in the
absence of his psychiatric problems, one could argue that
superimposed emotional and psychiatric factors might have
been an exacerbating factor, leading to early expression of
symptoms.
In October 1996, another private physician stated that it was
his clinical opinion that the veteran has suffered from major
affective disorder, bipolar I, with hypertension and angina
pectoris, each of which compound the other.
The veteran underwent a physical examination in January 2000
and additional studies in February 2000 to determine the
etiology of his hypertension and heart disorder.
In the January 2000 report, the VA examiner diagnosed the
veteran with arteriosclerotic heart disease, hypertensive
cardiovascular disease, and hypertension.
He opined that, if the veteran was agitated, his symptoms
could be aggravated by his bipolar condition in the manic
phase. He stated that, while in the manic phase the
veteran's blood pressure could be elevated and cause
difficulty, possibly aggravating the arteriosclerotic heart
disease.
The examiner also noted that, when the veteran's hypertension
was well controlled, as he appeared to be, he did not know
that it would produce any increase in his problems.
In an October 2002 addendum to the January 2000 examination
report, the VA examiner reviewed the results of the
additional testing, which showed heart disease.
The examiner stated that manic depression was not the cause
of high blood pressure; however, in terms of aggravation,
hypertension would only be affected if the veteran was manic
and over-productive and even then it might be normal.
In a VA examination in March 2004, the VA examiner concluded
that the diabetes mellitus was the cause of the coronary
artery disease and more than likely the cause of the
hypertension, but that the bipolar disorder could aggravate
the hypertension and coronary artery disease if the veteran
was excited, agitated or over active.
In a subsequent VA medical opinion in June 2005, the same VA
examiner stated he had been mistaken in the March 2004
examination when he stated that the diabetes mellitus caused
the coronary artery disease and more than likely the
hypertension.
In that regard, the examiner added that the veteran had had
hypertensive cardiovascular disease since 1973 and diabetes
mellitus since 2003. Thus, the time interval between the
development of the hypertension and cardiovascular disease
and the diabetes was far too long for diabetes mellitus to be
the cause.
However, the examiner maintained that there is no question
that the diabetes mellitus would aggravate the veteran's
coronary artery disease and his hypertension.
III. Analysis
The Board notes that the veteran is currently service-
connected for diabetes mellitus, currently evaluated as 20
percent disabling, and for a bipolar disorder, currently
evaluated at 70 percent disabling, for a combined rating of
80 percent disability.
In addition, he was granted a total compensation rating based
on individual unemployability effective in August 2002.
The veteran is now seeking service connection for
hypertension and a heart disorder, claimed as secondary to
his service-connected bipolar disorder. He essentially
contends that he developed his hypertension and heart
disorder as a result of his bipolar disorder.
Service connection may be granted for disability resulting
from disease or injury incurred in or aggravated by service.
38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303
(2005).
Service connection may also be granted for disability
proximately due to or the result of a service-connected
disability and where aggravation of a nonservice-connected
disorder is proximately due to or the result of a service-
connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown,
7 Vet. App. 439 (1995) (en banc).
In adjudicating a claim for benefits, the Board must
determine whether a preponderance of the evidence supports
the claim or whether all of the evidence is in relative
equipoise, with the veteran prevailing in either event, or
whether a preponderance of the evidence is against the claim,
in which case the claim must be denied. Gilbert v.
Derwinski, 1 Vet. App. 49, 53-56 (1990).
Considering the medical evidence of record, the Board finds
that the preponderance of the evidence is in favor of
granting the veteran's claims for secondary service
connection.
In essence, the Board finds that the veteran's current
hypertension and heart disorder are aggravated by his
service-connected diabetes mellitus and to a lesser extent by
his service-connected bipolar disorder.
The Board finds the VA examination conducted in March 2004
and subsequent medical opinion in June 2005, to be the most
probative evidence of record.
In that regard, the Board notes that the physician who
conducted the VA examination in March 2004, and provided the
medical opinion in June 2005, has been treating and
evaluating this veteran since at least 2000. Thus, he is
very familiar with the veteran and his history.
Further, the Board notes that his March 2004 report is based
upon an interview with the veteran, a review of his claims
file, and a comprehensive physical examination. Coupled with
his long-standing association with this veteran, the Board
gives great weight to his opinions and conclusions.
Moreover, the Board notes that in his June 2005 medical
opinion, he provided a sound rationale and basis for the
determination that his conclusion that the veteran's diabetes
mellitus caused his hypertension and heart disease was
erroneous.
Finally, the Board notes no evidence contradicting the
findings in the March 2004 VA examination and June 2005
medical opinion that the veteran's hypertension and cardiac
disease are aggravated by his service-connected diabetes
mellitus.
The Board also notes that, in 1996, two of the veteran's
private physicians opined that his hypertension and cardiac
disease could be aggravated by the service-connected bipolar
disorder particularly when the veteran was in a manic or
over-productive state.
This statement tends to support the recent opinion in
connection with the March 2004 VA examination.
Hence, the Board finds that that the hypertension and
arteriosclerotic heart disease are shown to have been
aggravated by his service-connected bipolar disorder though
to a lesser extent, since this is only likely to occur when
the veteran is over-productive or manic.
ORDER
Service connection for hypertension as secondary to service-
connected disability is granted.
Service connection for arteriosclerotic heart disease as
secondary to the service-connected disability is granted.
____________________________________________
STEPHEN L. WILKINS
Veterans Law Judge
Board of Veterans' Appeals
Department of Veterans Affairs